From my own experience, the profile of surgical site infections (SSIs) is low among staff. Judith Tanner and colleagues suggest that awareness of SSIs is also low among patients – for example, some patients only knew about Methicillin-resistant Staphylococcus aureus (MRSA) but had never heard of SSIs.[1] For these reasons, I feel we must change our approach and explore ways we can raise the profile of SSIs and how to prevent them.

Given my extensive experience of setting up a very successful SSI surveillance and prevention service at my previous healthcare organisation, I came up with an idea of having an annual SSI Prevention Day, similar to the annual hand hygiene days which are run by the World Health Organization (WHO). SSI Prevention Day (SSIPD) initiatives will aim to raise the profile of SSIs.

It is a huge honour and humbling experience to have lots of people supporting this call to action. We acknowledge that for an annual SSIPD to be effective, all key stakeholders must be involved and must actively participate. Key stakeholders include all healthcare professionals and those working in and accessing healthcare (consumers) covering a broad spectrum of specialisms. The initial piece of work focused on establishing what people thought of the proposals and whether they would be willing to support it. Thankfully most of the people I consulted felt that this initiative was very much needed, especially now. 

Raising the profile of SSIs

An idea that started with an initial focus on an annual SSIPD has now broadened to cover many other areas of SSI surveillance and prevention, patient safety and healthcare regulation.

We are proposing to raise the profile of SSIs through:

1. An annual SSIPD (or week)
2. Annual regulatory style SSI Prevention Inspections that will be fed back to regulatory organisations, Chief Nursing Officers (CNO), Chief Medical Officers (CMO) and responsible health ministers or politicians prior to the annual SSIPD and then fed back to the public during the annual SSIPD campaigns. We acknowledge that this notion of annual inspections may be viewed as problematic, as is standardisation in terms of scope of surveillance, as there is potential for 'box ticking'. We hope these proposals will open up dialogues between our country SSI champions and country regulatory authorities to perhaps consider mandating this.  
3. An SSI champion model that will give us an opportunity to standardise existing SSI surveillance and prevention processes in the UK and globally through our dedicated local hospital, regional, country and continent SSI champions. Proposed SSI champions will span a variety of healthcare professionals and consumers of healthcare.  See proposed SSIP champion model below with the areas we will focus on initially.

The SSIP champion model was inspired by Albert Gonzalez-Sagredo (Vascular Surgery Department, Bellvitge University Hospital, Spain) who gave us an insight into which areas we should focus on. See his paper attached below.

SSI Prevention champion model _ Albert (1).pdf

Eventually we hope to cover broader aspects of healthcare acquired infection (HCAI) surveillance too.

The benefits of the SSIP proposal

There are many benefits of adopting our patient safety proposals, including but not limited to:

• Promoting SSI prevention expertise from ward to board through compassionate local champions, experienced SSI prevention champions, patient safety and infection prevention and control experts.
• Providing a perfect opportunity for global collaboration and learning from each other for all countries involved.
• Opportunities for the CNO, CMO, politicians and journalists to champion an important patient safety initiative in the UK and globally.

Our journey so far

What started as just another tweet on the 24 April 2022 has become perhaps one of the best SSIP campaigns I have ever done on social media and other platforms. The momentum continues to build (see the tweets via #SSIPreventionDay and Twitter).

When I recognised that this initiative was generating a huge social media response, I submitted an abstract to the annual Infection Prevention Society (IPS) conference, which was accepted for a poster talk. This gave me the opportunity to share our SSIPD aspirations with many conference attendees, The conference was a huge success and I began to think this campaign could become as popular or even surpass the successes of the WHO annual hand hygiene campaign. Towards the end of 2022, with support from the CNO for England, I presented our proposals to the NHS England Head of Infection Prevention and Control. Engaging senior leadership will be central to our SSIPD initiatives campaigns.

We had our very first historical SSIPD initiatives inaugural brainstorm meeting, chaired by the wonderful Karen Wares (a very experienced Infection Prevention Champion and Clinical Director at Gama Healthcare), on the 4 January 2023.

We’re continuing with our call to action for a SSIPD, our SSIPD initiatives group continues to grow and we now have an active WhatsApp group with almost 50 people and an email distribution list with over 115 email recipients.

What’s next for us?

1. Follow up meeting in February 2023.
2. Design and send a questionnaire via our country CNOs and CMOs as a call to action and identification of SSI champions.
3. Continue building our network and formalising our SSISP group.

Conclusion

We’re proposing a novel hybrid patient safety initiative which we hope will bring tangible surgical benefits for patients. We believe our proposed SSIPD initiatives are feasible, given the level of interest this has already generated within a short timeframe. We have an ambition to embrace all healthcare workers and everyone involved in healthcare, media and science in our quest to bring about tangible patient outcomes. Thank you to our supporters and advocates who got us to where we are today… buzzing with excitement!

To find out more about the SSIP Initiative and to get involved, email ssipreventiondinitiatives@gmail.com.

Reference

1. Tanner J, Padley W, Davey S, et al. Patients’ experiences of surgical site infection, J Infect Prevent 2012; 13 (5). https://doi.org/10.1177/1757177412452677

Further resources on the hub

See our surgical site infections area of the hub.

The initial patient response rate for Isla was 87.3%, and the majority of patients (73%) remained engaged throughout the 30-day period. There was no significant difference in age, gender, operation type or distance to hospital between Isla responders or non-responders, or if the hospital provided a photo at discharge or not. Patients using Isla had a shorter post-discharge stay (P = 0.03), although this was not attributed to the platform. Patients not owning a smartphone and a technical issue were the main barriers to participation. Overall, nine SSIs were recorded, eight through the Isla surveillance and one through a hospital transfer readmission. The carbon emission associated with the SSI ranged from 5 to 2615 kg CO2e.

The authors concluded that in a real-world setting, using patient smartphones is an effective method to collect PDS, including wound images.

The QIP helps healthcare professionals to:

• Use tools to understand prevalence of SSIs.
• Consider what aspects of care, process, culture or behaviour may be contributing to the prevalence of SSIs.
• Identify which aspects to focus on first to realise the greatest chance of improvement.
• Identify the improvement tools that will best suit the individual project.

Click on the link below to request the QIP document.

Patient Safety Learning and Mölnlycke* are creating a short video that will, for the first time, profile the experiences of people who have contracted an infection after surgery. The video will include short written testimonials from people about what it means to contract an infection, and the impact it can have. The information from this survey will help to inform this video, with the results being highlighted as patient testimonials to anonymously profile your experiences with infections.

The finalised video will be shared with policymakers, MPs and the media to bring greater attention to the damaging impact of infections on patients, and increase awareness of the importance of prioritising this area of clinical care. It will also be used more broadly by Mölnlycke within both educational and promotional materials to ensure that the profile of infections are raised across a range of audiences. We hope this will bring positive change to the current approach to the management of infections, and ensure future patients have the greatest chance to avoid contracting surgical infections. 

If you would like to share your experiences over the phone, or learn more about the project, please contact molnlycke@lexcomm.co.uk

*This project is support by Mölnlycke, a world-leading medical solutions company which designs and supplies medical solutions to enhance performance in healthcare – from the hospital to the home. 

“I was not able to walk for weeks until it had healed up. The impact was quite dramatic.” (Patient account)

About the project

This project, sponsored by Mölnlycke*, invites patients who have experienced an infection following surgery to share their experiences by being interviewed. These patient insights will be used to create a ‘Digital Storybook’, alongside interviews with healthcare workers. 

Key aims:

• To raise awareness of how infections following surgery can affect a patient and/or their families and carers. This might include physical, emotional or professional impact.
• To help improve current infection control measures.
• To reduce the risk of surgical infection for future patients. 

How will this be shared?

Once finalised, the Digital Storybook will be made publicly available and shared widely with policymakers, MPs, healthcare leaders and the media. It will be used as a campaigning tool to influence change and call for action. 

How do I get involved?

If you’ve had an infection following surgery and would like to share your experience for the Digital Storybook project, please contact Michael Latham by email Michael.Latham@lexcomm.co.uk or telephone 07795995870. 

You can read more about Mölnlycke and the detail of the project in the attached document, ‘Information for participants’.

*This project is sponsored by Mölnlycke, a medical solutions company which designs and supplies medical solutions to enhance performance at every point of care – from the operating room to the home.

Related reading:

Time to Act: A state of the nation report on surgical site infections in the UK

Resources on surgical site infections